| NPI | 1831771351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA RANDALL Executive Director 406-782-0461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| Enumeration Date | 2021-04-23 |
| Last Update Date | 2023-03-23 |